HomeMy WebLinkAbout2004-P07859 - addn/remodel/repair �
% � PERMIT
C�T*Y` ��F O RO N O Permit Number:
2750 Kelley Parkway - PO Box 66 P07859
Crystal Bay, Minnesota 55323 P@1"CTllt Typ2: Addition/RemodeURepair
(952) 249-4600 Date Issued: g�3o�2ooa
SITE ADDRESS: 315 Hollander Rd
Wayzata,MN 55391
PID: 25-118-23-43-0014
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Buildin Census Code 434
Pemut Class: g
Pernut Type: Addition/RemodeURepair Pernut Sub-type(s): Addn/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate pernuts required: riumoing iviecnanicai Eiec;uicai�staiej
NOTICES/REMARKS:
T_'___1_1 __'"_�"___i_"`_l__'_ __a____ O_ T T AT___"____11_ _'..1___""_]_____
a�v�.�v�v�v�uv�a������avaav �—u��aab w va� .�v.. .rw��au u�a�u rru�uvrr�
FEE SUMMARY: PermitFee: $ 1,094.55 Valuation• $ 118,000.00
Plan Review Fee: $ 718.83
State Surcharge Fee: $ 60.50
TOTAL FEE: $ 1,873.88
APPLICANT: Jones Design Build OWNER: Nathan&Constance Fagre
4780 Fatima Place 315 Hollander Rd
Shorewood,MN 55331 Wayzata MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK 1N SI'RICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND SI'ATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
,
� - � ' C, G�
� _ , �,
PLICANT E IGNATURE 1 SUED BY SIGNATURE
Copies: 1-File(Si,enitures Required), 1-Applicant, 1-Monthlv Revorts, 1-Assessin�, 1-Finance Page 1
� « � $�L�l o�
Total Fee: $ � /87 3. $8' Date Received: �/� �6�
Entered By: Permit#: RD 7555
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all inforination)
---------------------------------------------------------------------------------- -------------------------------------
THE APPLICANT IS: (circle one) OWNER - DNTRACTO
JOB SITE ADDRESS: ✓�� ���'�� ��p� ZIP: �j�, �
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes �No If yes, a special event permit is required with Police Department and City
Council approval 60 days prior to the event. Non permitted events will not
be allowed.
NAME OF OWNER: ��'F;� N1'bV, �CA`�PI�I.� �.p� PHONE: (home) Z�
(work)
MAILING ADDRESS: �l� '���V�p(���CITY: �rZy1O ZIP: l{���
`�`�"rtT
CONTRACTOR: PHONE: �'JZ•�.��(
CONTACT PERSON: MOBILE/PAGER: ��2•�.�'l�
MAILING ADDRESS: CITY: ��l'�I'� ZIP: ??r--��
STATE LICENSE: # G�'p�,�j
ARCHITECT/ENGINEER: I'��/NGt,` PHO E: lpfZ•� . Z
MAILING DRE S: C� ITY: ZIP:
NAME: �1 r�VQ�pyv� REGISTRATION # �{-Z��
TYPE OF WORK: New Accessory Structure
Addition Move
RemodeUAlteration�_ Land Alteration
PROPOSED WORK(desc ibe in detai�: � � �'
W �
STORIES: 'ji SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ ��j �''j .�
I hereby apply for a building permit and I aclrnowledge that the information above is complete and accurate; that the
work will be in conformance with the ordinances and codes of the City and with the State Building Code; that I
understand this is not a permit and work is not to start without a permit; and that the work will be in accordance with
the approved plan.
APPLICANT'S SIGNATURE: DATE: �
�
; ,
;
Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd.1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section.
Subd.2. Information required to be given individ�al. An individual asked to supply private or confidential data concerning himself shall be
informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b)
whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
private or confidential data;and(d)the identity of other persons or entities authorized by state or federai law to receive the data. This requirement shall
not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law entorcement officer.
The commissioner of revenue mav alace the notice required under this subdivision in the individual income tax or property tax refund
instructions instead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of
stored data on individuals,and whether it is classi£ed as public,private or confldentiaL Upon his further request,an individual who is the subject of
stored private or public data on individuals shall be shown the data without any charge to him and,if he desires,shall be informed of the content and
meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six
months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The
responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may
require the requesting person to pay the actual costs of making,certifying,and compiling the copies.
The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the
date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible.If he cannot comply with the requestwithin
that time,he shall so inform the individual,and may have an additional five days within which to comply with the request,excluding Saturdays,Sundays
and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data
concerning himself. To exercise this rig6t,an individual shall notify in writing the responsible authority describing the nature of the disagreement. The
responsible authority shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of
inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correct. Data in
dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating to
contested cases.
DATA PRIVACY ADVISORY
In accordance with M.S.13.04,Subd.2,"Rights of subjects of data",we would like to inform you that your request
for a permit or license from the City of Orono or any of its departments may require you to furnish certain private or
confidential information.
You are notified that:
1. The information you furnish will be used to determine your qualification for the permit or license requested.
2. You may refuse to supply data,but refusal may require that the City deny the permit or license.
3. The information may be shared with other local,state or federal agencies to the extent necessary to process
the permit or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
5. You have certain rights under M.S. 13.04(available upon request)to review private data on yourself.
6. Your full name is required to process this application or permit.
���1�
First Middle Last
Address
City State Zip Phone
I underst y rights as stated above.
Signatur
4
� ,
CHECK Ok�k' LIST FOR ISSUANCE OF PERMITS
, FOR OFFICE USE ONLY
ADDRESS OR LEGA�,: 3l 5 h4 oc,.c.,rAt� D�tZ ��.4+� �
PID:
DESCRIPTION OF WORK: (i�vvc,u,pC�
ZO�G REY�tiY BY: N I iA ---------------DATE APPROVED: ------------------
BUII.,DI�i iG REV�`V BY: . DAT'E APPROVED: �-Z 3- o�f
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERNIIT Yes ✓� No
PLAl�T REVIEW Yes � No SEWF�CONNECI'ION
STATE SURCHARGE Yes �/ No WATERCONNECTTON
INVESTIGATION FEE � Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC�Units OTHER (specify)
ZONING CHE.CK LIST Zoning Districc: r!� C/-�i4N�,Q .
v
Fire Department: Post Office: School District: •
Lot Area: Sq.ft. Acres � Width Depch
Survey Submitted: Yes o Date of Survey:
Proposed Setbacks:
Front(Lake): Right 'de:
Rear(Street): Left Side:
Adjacent Structures: Wetl d:
Building Hei�ht: Def. Hgt. Pe Hgt.
Lot Coverage:
Gradina: Staff Approval Date: By: Council Approval Date:
Septic: Scaff Approval Date: By:
Zoning File: # Resolution: f# Resolucioa Date: �
Shoreland District: �
Avg. Setback: Bluff Setba k: I.ocCoverage:
ExisCmo Proposed
Hazdcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes o Date of Council Approval:
REl�'LARSS (in house):
7
�
, , "
BUII.,DING REVIEW CI�CK LIST
�C� (` � CONSTRUCTION TYPE: ��U
_ Sq Footage $Per Sq Ftg
Basement . x _
Ist Floor X . _
2nd Floor z =
Garage x _ �
x =
TOTAL
Estimated Construction Vaiue: $_ �I�BfbOc7 �
Inspections Required: `vork Requiring Separate Permits:
Site �_Plumbing Fire
Hazdcover Removal OC Mechanical Water Connection
Footing ` Septic Sewer Connection �
___�_Framing Fireplace Lawn Irrigation
�_Insulation (Masonry) Other
�Wall Boazd • (Mfg.) Well (State Permit)
F�� Grading/Filling DC Electrical (State Permit)
Other
1tEMA]E2KS(Pi T HOUSE): .
REV�W BY OTHERS: DATE: ------------------------------------------------
Access: Ezisting New .
Access Approval: Date gy; �
RENL�i.RKS (TO BE NOTED ON PER1vII1�;~---------------------------------------------------------
8
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��� DAT TIME �
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D TE TIME
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